Wednesday, October 24, 2018

Medicare for all -- what is it? -- Oct. 11, 2018 column (posted belatedly, so out of order)

By MARSHA MERCER

Candidate Donald Trump
promised better, cheaper healthcare for all.

Just days before his
inauguration, he said he’d deliver “insurance for everybody.” His plan to
repeal and replace the Affordable Care Act would come “in a much simplified
form – much less expensive and much better,” he told The Washington Post.

It never happened.
About 28 million Americans remained uninsured last year, up from 27.3 million from
2016, according to a Census Bureau report released last month.

Trump finally did come
up with an alternative, of sorts. His administration unveiled new rules in
August to allow skimpy, low-cost, short-term insurance plans that critics called
junk.

These plans lack the
10 essential health benefits required in ACA exchange plans. If healthy people
choose the new plans to save money, it could raise insurance costs for sicker
people in the plans, analysts warn.

Coverage of
pre-existing conditions -- the most popular element of Obamacare – animates
many midterm contests, as House Republicans who voted to repeal Obamacare
scramble to assure voters they’ll protect that coverage.

Emerging in the
midterms and likely a hot issue for the 2020 presidential race is “Medicare for
all.”

Asked if they support
Medicare for all, seven in 10 people said they do, a Reuters-Ipsos poll in
August reported. That includes 85 percent of Democrats and 52 percent of
Republicans.

But what, to paraphrase
Freud, do consumers want?

“Medicare for all” is
shorthand for a range of plans.

Medicare for All –
with a capital A -- would throw out the current employer-based health insurance
system and replace it with a single-payer, government plan. It is what Sen. Bernie
Sanders, independent of Vermont, proposes.

But Medicare for all
-- lower case a – could describe various national plans proposed by Democrats
that would move incrementally toward universal healthcare coverage.

Two questions in a Kaiser
Family Foundation survey in March illustrate how wording of the question matters.

Asked: “Do you favor
or oppose having a national health plan, or Medicare-for-all, in which all Americans would get their insurance
from a single government plan?” about 60 percent said they favor it.

But when asked about “having
a national Medicare-for-all plan open to anyone who wants it but people who currently have other coverage could keep what
they have,” support surged to 75 percent.

Sanders, who first
introduced a single-payer bill in 1993, is not as lonely as he once was. His
Medicare for All bill has about 15 cosponsors.

About 70 Democrats in
Congress have formed a Medicare for All Caucus, and a Democratic House member
from Washington state announced a Medicare for All PAC to back candidates
financially.

On his website, Sanders
is unequivocal: “Health care must be recognized as a right, not a privilege . .
. The only solution to America’s health care crisis is a single-payer national
health care program.”

The sticking point, of
course, is the cost. Sanders insists individuals would save money on insurance
and medical bills, but both the liberal Urban Institute and libertarian-leaning
Mercatus Institute at George Mason University estimated federal expenditures would
rise at least $32 trillion in the first 10 years.

The Congressional Budget Office has not run estimates, apparently
because Sanders’ plan has so little chance in the Republican-controlled
Congress.

As president, Barack
Obama backed away from a single-payer plan, but he now calls Medicare for all a
“good new idea.”

Democratic Sens. Tim
Kaine of Virginia and Michael Bennet of Colorado are cosponsors of Medicare X,
a phased-in plan that would allow all Americans to buy into Medicare. Starting
in counties where the ACA exchanges lack competition, itwould open nationwide in 2023 and to
businesses in 2024.